Pediatric CRRT Nurse Model: The Transition to an ICU based Model.

T Mottes, J Vamos, W Wieneke, J Juno

Over the past 16 years our patient activity has increased by 65%, from 14 to 40 patients in the past year. Our current nursing care delivery model consists of the pediatric dialysis nursing staff providing the set up, prime and initiation, while the PICU nursing staff provides the bedside hourly care. The increased activity along with projected continual growth would stretch our current care delivery model past its current adaptive potential. Thus, the need to explore other models became imperative to maintaining our existing level of patient care. Our new model allows for continued growth, is fiscally responsible, compliments the excellent nursing bedside care and doesn’t overburden the nursing staff with its implementation. With those goals in mind, a model was developed with the care being shifted from the pediatric dialysis nursing staff to the pediatric ICU nursing staff.

Transition to the new care delivery model necessitated the implementation of a training program, along with the creation of a nursing leadership position, the program coordinator, designed to train the ICU staff to assume the set up and initiation responsibilities. The Initiator Education program consists of 3 Steps; Hands-on demonstration of the machine set up and the different initiation procedures, 5 assisted patient initiations, and ongoing education, including CRRT drills. This training program is in addition to the current education program for CRRT.

During the transition to it is important that we track the effects on the nursing staff. To measure these effects a survey tool was developed that has the staff rank their perceived comfort and knowledge of CRRT. During the transition period, the survey will be implemented every 4 months, with first survey being just prior to the start of the transition process. In brief summary, the baseline survey results with 72% of all CRRT trained nurses responding indicate an overall comfort level average score of 4.2. During this transition time, evaluating and trending the data will allow us to adapt to the nursing education needs.

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